Abstract

A 48-year-old female presented with slowly progressive, asymptomatic hair loss on the scalp for several years. Physical examination of the scalp demonstrated decreased hair follicle density on the crown without erythema or scale. Scalp biopsies from the affected areas revealed moderate reduction in terminal hair follicles, miniaturized hairs, retention of sebaceous glands, and multiple double-layered small ducts with pale cytoplasm and intraluminal secretions. The histopathologic findings were consistent with non-cicatricial alopecia and clear cell syringomas. Upon further questioning, the patient reported a history of eruptive syringomas since childhood. Physical examination at follow-up visit revealed multiple smooth, pink to light-brown monomorphic papules on the chest, anterior neck, and periorbital skin consistent with eruptive syringomas. Laboratory evaluation including hemoglobin A1c and complete metabolic panel were normal. Eccrine duct dilation and syringomas-like sweat duct proliferations have been described as reactive changes in the setting of cicatricial and non-cicatricial alopecias. Some authors consider this to be an incidental finding while other authors believe that syringomas may lead to progressive hair loss. In our patient, the sweat gland proliferation was morphologically distinct from the eccrine duct dilation commonly seen in cicatricial alopecia. We present a unique and interesting case of a patient with progressive non-cicatricial alopecia of the scalp with concomitant eruptive clear cell syringomas.

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